Heart rate turbulence in adults with repaired tetralogy of Fallot

Davos, Constantinos H.; Moutafi, Antonia C.; Alexandridi, Anastasia; Petropoulou, Evdokia; Varela, Emily; Chamakou, Aikaterini C.; Francis, Darrel P.; Kilner, Philippe J.; Piepoli, Massimo F.; Gatzoulis, Michael A.

doi:10.1016/j.ijcard.2008.03.096

« Previous Next »International Journal of Cardiology
Volume 135, Issue 3 , Pages 308-314, 10 July 2009

Heart rate turbulence in adults with repaired tetralogy of Fallot

Constantinos H. Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
- Adult Congenital Heart Program, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK
- Corresponding author. 4 Soranou Ephessiou Street, 115 27 Athens, Greece. Tel.: +30 210 6597392, +30 210 6597405; fax: +30 210 6597405.
Antonia C. Moutafi
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
Anastasia Alexandridi
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
Evdokia Petropoulou
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
Emily Varela
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
Aikaterini C. Chamakou
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
Darrel P. Francis
- National Heart and Lung Institute, Imperial College of Science and Medicine, London, UK
Philippe J. Kilner
- Department of Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
Massimo F. Piepoli
- National Heart and Lung Institute, Imperial College of Science and Medicine, London, UK
Michael A. Gatzoulis
- Adult Congenital Heart Program, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK
- National Heart and Lung Institute, Imperial College of Science and Medicine, London, UK

Received 17 December 2007; accepted 7 March 2008. published online 07 July 2008.

Abstract

Background

Tetralogy of Fallot (ToF) patients face an increased risk of sudden cardiac death late after repair. Heart rate turbulence (HRT) indices are well-known predictors of sudden cardiac death. We aimed to estimate whether HRT is impaired in repaired ToF patients compared to healthy controls and relate those HRT parameters to already recognized prognostic markers.

Methods

Continuous ECG recordings were performed in 19 patients late after ToF repair (36.3±12.4 years, 26.6±7.1 years after repair) and 20 age-matched healthy controls (40.8±8.1 years). Turbulence slope (TS) and onset (TO), frequency and time domain heart rate variability parameters and QRS duration were estimated. Volumes of the right (RV) and left ventricle (LV) and ejection fraction (EF) were assessed by cardiovascular magnetic resonance imaging. Cardiopulmonary exercise testing was used to estimate peak oxygen consumption (VO₂) and VE/VCO₂ slope.

Results

TS (15.95±9.41 vs 28.73±12.24 ms/RRI, p=0.0007) and TO (−0.98±2.06% vs −3.45±3.25%, p=0.007) were found to be significantly different between ToF patients and controls. TO correlated with LVEF (r=0.47, p<0.05), LVSVi (r=0.50, p=0.03), RVEF (r=0.53, p=0.02), peak VO₂ (r=0.50, p=0.05), VE/VCO₂ slope (r=−0.55, p=0.03) and with heart rate variability frequency domain indices (log LF, r=0.47, p=0.04, log HF, r=0.56, p=0.01).

Conclusion

HRT indices are impaired in ToF patients late after surgical repair compared to healthy controls and relate to coexisting haemodynamic, ventilatory and autonomic impairment. A clinical prognostic role of HRT may be speculated, which warrants further investigation.

Keywords: Turbulence, Tetralogy of Fallot, Sudden death, Surgery, Autonomic nervous system, Arrhythmia